What is Wrong with Free Lunch?

Pharmaceutical-Physician Relationship

Reactors

Dr. Edna Victoria G. Monzon Dr. Angeles T. Alora

Dr. Bienvenido Tiangco

Case Scenario 1

CME Cardiology– held at Beijing, China

Drug Company A• Sponsors 12 cardiologists,

15 fellows, 4 IM residents • Treats the group at a fancy

buffet lunch prior to the scheduled flight

Drug Company B• Sponsors 6 cardiologists and

6 fellows• Treats the physicians packed

lunch to stave off hunger

Question

From the code of ethics, how many doctors can a pharmaceutical company sponsor in an international (regional) trip for CME?

A. 6B.7C.10D.12

The Trip to Beijing

• Drug Company A– Flies residents/fellows

on Business class– Flies consultants on First

class

• Drug company B- Reserved Economy class

seats for all physicians

Drug Company A: Hong Kong Side Trip

Question If u were a participant of this

convention, what will you do?A. Join the group to Hong kong for shopping and

sight-seeing c/o pharmaceutical companyB. Stay at the hotel and prepare for the

conventionC. Join the group to Hongkong for sight-seeing

using ones own moneyD. Go to Hongkong with family for sight-seeing

The Hotel RoomDrug Company A Drug Company B

Sight-Seeing After the Convention…

What is Wrong With Free Trips?

CAN PHAP MEMBERS SUBSIDIZE DOCTORS’ EXPENSES FOR CME?

• YES, provided:

Scientific objectives should be the primary focus of meetings

CAN PHAP MEMBERS SUBSIDIZE DOCTORS’ EXPENSES FOR CME?

• Sponsorship not conditional upon any obligation to prescribe or promote any product

• Sponsorship limited to economy travel to and from venue. NO SIDE TRIPS.

• Company can subsidize meals, registration and accommodation for the duration of CME with maximum additional of 2 days only(EX: if CME runs for 5 nights, company may pay for up to 7 nights). Arrival/departure dates are considered.

CAN PHAP MEMBERS SUBSIDIZE DOCTORS’ EXPENSES FOR CME?

• NO CASH ASSISTANCE • Family/spouses not allowed unless medically

qualified and practicing in a therapeutic area relevant to the CME

• Honoraria/compensation not allowed unless healthcare professional attending as speaker

C M E• OVERSEAS

Max of 7 doctors per company. More than this no., rationale of overseas vs. in-country meeting becomes questionable.

• REGIONAL (ASEAN countries, Hong Kong, Taipei and China)Max of 12 doctors per company

• LOCALMust be in appropriate business centers, not resort locations. Participants to pay for registration fees.

Case Scenario 2

• Dr. Jimmy A. Gipp is celebrating his birthday. In celebration, Ms. Em Gibbalot, a pharmaceutical representative, gives him a present… 2 presents to be exact. In “gratitude”, Dr. Gipp assured Ms. Gibbalot of his support for her covered products.

Is gift-giving allowable?

Question

Is gift giving allowed?A. YesB. No

• Dr. Enid T. Hings has her own private clinic. Ms. Gibbalot donates equipment that Dr. Hings can use in her practice.

Are donations allowed?

Question

Are donations allowed?A. YesB. No

GIFTSGifts shall not cause undue influence on prescribing, nor

have an appearance of impropriety in the public eye.Gifts allowed if they result in significant benefits for

patients and medical practice, if: less than PhP 1,000.00 primarily involves a benefit to patients specific to the practice of medicine or related to

healthcare professional's work (pens, notepads)No strings attached.Cultural gifts

(Christmas and other religious holidays) are allowed

Birthday gifts are not allowed

DONATIONS Pieces of equipment, tools, devices and

educational materials may be donated or loaned to medical training institutions and hospitals but not to individual or individuals.

Items must have direct use in medical care and diagnosis

ECG machines stethoscopes X-rays scanners diagnostic equipment medical books, etc.

Case Scenario 3

It is a busy day in the office, but you have agreed to speak for a minute to a pharmaceutical representative , knowing your interest in golf, he has brought you golf balls and sports bag emblazoned with the drug’s initials…

Question

May golf balls and sports bags be provided if they bear a company or product name?

A. YesB. No

Question What if the drug representative

gave you a leather medical bag (P999) with the drug initials emblazoned on it, would you accept it?

A. YesB. No

Promotional Materials

• Promotional giveaways should not be of a nature of economic value (i.e., valued at less than PI000.00),

• Items of higher cost may be donated to institutions (such as medical societies, professional organizations, and hospital departments) but never to individuals.

Pharmaceutical branding of Resident Physicians

• Survey of 181 primary care residents; 164 (91%) responded.

• First asked to complete survey, then asked to empty pockets of white coats.

• 97% of residents were carrying at least one item with pharmaceutical insignia.

JAMA 2001;286:1024

Pharmaceutical Branding of Resident Physicians

JAMA 2001;286:1024

Frequency of items found in residents' white coats

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Pharmaceutical Branding of Resident Physicians

JAMA 2001;286:1024

Frequency of items found in residents' white coats

14

85

31

55

9079

45

0

20

40

60

80

100

% o

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iden

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Case Scenario 4

• During a medical convention a drug company sponsored a quiz bee (3 participants/team) regarding atherosclerosis and also provided questions on current events. The winners will then receive the following prizes:– 1st place-p10,000+air conditioning unit – 2nd place – 5,000+water dispenser– 3rd place-3,000+coffee maker.

Question

Is sponsorship of quiz contests allowable?A. YesB. No

RAFFLES AND COMPETITIONS

• Raffles and competitions permitted only during official conventions organized by the PMA or its affiliates and not in conflict with any of the official convention activities.

• Competitions must be based on medical knowledge or on the acquisition of it.

COMPETITIONS

• Must be based on medical knowledge

• Prizes must be relevant and specific to the practice of medicine

• Prizes offered are to be of low monetary value

Case Scenario 5

• This year’s team building is set at a nearby beach resort outside Manila. Company A offers to sponsor the activity.

• Is this allowed?A. YesB. No

TEAM BUILDING vs SCIENTIFIC MEETING

• Member companies SHOULD NOT specifically support sports events, such as golf tournaments, or charity or fund-raising activities, such as movie premieres.

• 12.2 Sponsorship of events, such as fellowship night, if the event is clearly part of a scientific meeting, is acceptable as long as such sponsorship is on a modest scale and does not involve star talent that would attract public attention.